Natural History of IgE-Mediated Fish Allergy in Children

Xepapadaki, Paraskevi; Christopoulou, Georgia; Stavroulakis, G.; Freidl, Raphaela; Linhart, Birgit; Zuidmeer, Laurian; Lakoumentas, John; Ree, Ronald van; Valenta, Rudolf; Papadopoulos, Nikolaos G.

doi:10.1016/j.jaip.2021.04.007

Cited by 28 publications

(35 citation statements)

References 32 publications

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“…One study showed that only 15% of children outgrow their fish allergy within a period of 2 to 5 years ( 104 ). It has been recently shown in a prospective clinical study that tolerance of fish increased with age, ranging from 3.4% in preschool children to over 45% in adolescents ( 105 ). Tolerance of fish was defined by a negative OFC to cod, whereas a positive outcome to any fish challenge or a specific IgE value to cod (f3) > 20 kU/L was defined as an active fish allergy.…”

Section: Fish Allergy Diagnosismentioning

confidence: 99%

Fish Allergy Around the World—Precise Diagnosis to Facilitate Patient Management

et al. 2021

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The accurate and precise diagnosis of IgE-mediated fish allergy is one of the biggest challenges in allergy diagnostics. A wide range of fish species that belong to evolutionary distant classes are consumed globally. Moreover, each fish species may contain multiple isoforms of a given allergen that often differ in their allergenicity. Recent studies indicated that the cross-reactivity between different fish species is limited in some cases and depends on the evolutionary conservation of the involved allergens. Fish allergens belong to several protein families with different levels of stability to food processing. Additionally, different preparation methods may contribute to specific sensitization patterns to specific fish species and allergens in different geographic regions. Here, we review the challenges and opportunities for improved diagnostic approaches to fish allergy. Current diagnostic shortcomings include the absence of important region-specific fish species in commercial in vitro and in vivo tests as well as the lack of their standardization as has been recently demonstrated for skin prick test solutions. These diagnostic shortcomings may compromise patients' safety by missing some of the relevant species and yielding false negative test results. In contrast, the avoidance of all fish as a common management approach is usually not necessary as many patients may be only sensitized to specific species and allergens. Although food challenges remain the gold standard, other diagnostic approaches are investigated such as the basophil activation test. In the context of molecular allergy diagnosis, we discuss the usefulness of single allergens and raw and heated fish extracts. Recent developments such as allergen microarrays offer the possibility to simultaneously quantify serum IgE specific to multiple allergens and allergen sources. Such multiplex platforms may be used in the future to design diagnostic allergen panels covering evolutionary distant fish species and allergens relevant for particular geographic regions.

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Section: Fish Allergy Diagnosismentioning

confidence: 99%

Fish Allergy Around the World—Precise Diagnosis to Facilitate Patient Management

et al. 2021

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“…The current guidelines recommend periodic re-evaluation with supervised OFCs to monitor for resolution [ 55 , 57 ]. Results from studies of children with IgE-mediated fish allergy suggest that they may be able to tolerate fish species other than those associated with the initial onset of symptoms [ 63 ]. Observational studies of fish-FPIES show that a certain percentage of children tolerate species other than fish identified as the culprit [ 16 ].…”

Section: Food Protein-induced Enterocolitis Syndrome (Fpies) Caused By Fishmentioning

confidence: 99%

Alternative Fish Species for Nutritional Management of Children with Fish-FPIES—A Clinical Approach

et al. 2021

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In the Mediterranean region, fish is a common cause of food protein-induced enterocolitis syndrome (FPIES) in children. No laboratory tests specific to FPIES are available, and oral food challenge (OFC) is the gold standard for its diagnosis and testing for achievement of tolerance. Children with FPIES to fish are usually advised to avoid all fish, regardless of the species. Fish are typically classified into bony and cartilaginous, which are phylogenetically distant species and therefore contain less cross-reacting allergens. The protein β-parvalbumin, considered a pan-allergenic, is found in bony fish, while the non-allergenic α-parvalbumin is commonly found in cartilaginous fish. Based on this difference, as a first step in the therapeutic process of children with FPIES caused by a certain fish in the bony fish category (i.e., hake, cod, perch, sardine, gilthead sea bream, red mullet, sole, megrim, sea bass, anchovy, tuna, swordfish, trout, etc.), an OFC to an alternative from the category of cartilaginous fish is suggested (i.e., blue shark, tope shark, dogfish, monkfish, skate, and ray) and vice versa. Regarding the increased mercury content in some sharks and other large species, the maximum limit imposed by the European Food Safety Authority (EFSA) for weekly mercury intake must be considered. An algorithm for the management of fish-FPIES, including alternative fish species, is proposed.

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“…6 However, the capacity of fish to trigger an allergic reaction is individual-and species-specific. [7][8][9] Fish-allergic individuals can demonstrate sensitization to a narrow range of fish, which may be difficult to predict because the current diagnostic capability is generally limited to a few well-studied species. 10,11 Diagnostics and management are further complicated by a range of immunological and/or clinical cross-reactivities reported to other related vertebrates such as frog and chicken (fish-chicken syndrome).…”

Section: Introductionmentioning

confidence: 99%

The first reptilian allergen and major allergen for fish‐allergic patients: Crocodile β‐parvalbumin

Ruethers

Nugraha

Taki

et al. 2022

Pediatric Allergy Immunology

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Background Clinical cross‐reactivity between bony fish, cartilaginous fish, frog, and chicken muscle has previously been demonstrated in fish‐allergic patients. In indicative studies, two reports of anaphylaxis following the consumption of crocodile meat and IgE‐cross‐binding were linked to the major fish allergen parvalbumin (PV). This study investigates IgE‐binding proteins in crocodile meat with a focus on PV and their clinical relevance. Methods Proteins were extracted from muscle tissue of crocodile, three bony fish, and two cartilaginous fish. A cohort of fish‐allergic pediatric patients (n = 77) underwent allergen skin prick testing (SPT) to three fish preparations (n = 77) and crocodile (n = 12). IgE‐binding proteins were identified and quantified by SDS‐PAGE, mass spectrometric analyses, and immunoblotting using commercial and in‐house antibodies, as well as individual and pooled patients’ serum. PV isoforms were purified or recombinantly expressed before immunological analyses, including human mast cell degranulation assay. Results Of the tissues analyzed, PV was most abundant in heated crocodile preparation, triggering an SPT of ≥3 mm in 8 of 12 (67%) fish‐allergic patients. Seventy percent (31 of 44) of fish PV‐sensitized patients demonstrated IgE‐binding to crocodile PV. Crocodile β‐PV was the major IgE‐binding protein but 20‐fold less abundant than α‐PV. Cellular reactivity was demonstrated for β‐PV and epitopes predicted, explaining frequent IgE‐cross‐binding of β‐PVs. Both PV isoforms are now registered as the first reptile allergens with the WHO/IUIS (β‐PV as Cro p 1 and α‐PV as Cro p 2). Conclusion Fish‐allergic individuals may be at risk of an allergy to crocodile and should seek specialist advice before consuming crocodilian meat.

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Natural History of IgE-Mediated Fish Allergy in Children

Cited by 28 publications

References 32 publications

Fish Allergy Around the World—Precise Diagnosis to Facilitate Patient Management

Fish Allergy Around the World—Precise Diagnosis to Facilitate Patient Management

Alternative Fish Species for Nutritional Management of Children with Fish-FPIES—A Clinical Approach

The first reptilian allergen and major allergen for fish‐allergic patients: Crocodile β‐parvalbumin

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